Provider Demographics
NPI:1780929364
Name:CENTEL HEALTHCARE INC
Entity type:Organization
Organization Name:CENTEL HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-943-6208
Mailing Address - Street 1:PO BOX 2429
Mailing Address - Street 2:PETERSBURG
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23804-2429
Mailing Address - Country:US
Mailing Address - Phone:804-943-6208
Mailing Address - Fax:
Practice Address - Street 1:803 HINTON ST
Practice Address - Street 2:SUITE 308
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3028
Practice Address - Country:US
Practice Address - Phone:804-943-6208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA07266125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health